Bottom Line:
However, the caudal spread was greater in the extension than in the flexion group.In the extension group, the contrast medium spread caudally about twice as far as it spread cranially, but there was no statistically significant difference between cranial and caudal spread in the flexion group.The flexion of the neck increased cranial spread and extension of the neck increased caudal spread.

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Background: Neck flexion has been shown to increase cranial spread of contrast agent when a small fixed volume was injected into the high thoracic epidural space. The purpose of this study was to evaluate the effect of volume of contrast medium on its distribution through the high thoracic epidural space during neck extension and flexion using the rabbit model.

Methods: An epidural catheter was introduced into the epidural space of New Zealand white rabbits with the tip located at the T3-4 intervertebral level. The neck was extended or flexed (n = 8 for each group), and the contrast medium was injected with the volume increasing by increments of 0.1 ml/kg, up to 0.3 ml/kg. The spread of contrast medium was determined by counting the number of vertebral body units using lateral epidurographic images.

Results: In both groups, the total spread of contrast medium was similar, increasing continuously with injected volume. The cranial spread was greater in the flexion group than the extension group. However, the caudal spread was greater in the extension than in the flexion group. In the extension group, the contrast medium spread caudally about twice as far as it spread cranially, but there was no statistically significant difference between cranial and caudal spread in the flexion group.

Conclusions: In the high thoracic epidural space of rabbit, the contrast medium of varying doses showed limited cranial spread. The flexion of the neck increased cranial spread and extension of the neck increased caudal spread.

Figure 2: Cranial and caudal spread of contrast medium in the high thoracic epidural space during extension or flexion of the neck. Cranial spread was greater in the flexion group, while caudal spread was greater in the extension group, *P < 0.05 versus the extension and flexion groups. Data are shown as box-and-whisker plots (10th percentile, 25th percentile, median, 75th percentile, 90th percentile). Cranial spread is expressed as positive values on the vertical axis, and caudal as negative values.

Mentions:
The cranial spread was greater in the flexion group than the extension group at the doses tested (Fig. 2) (P < 0.05). In the extension group, the median radiographic spread to the cranial direction was 3.5 VBU (2.6-3.5) [2.5-4.5], 4.3 VBU (3.5-5.5) [3.5-6.0], and 5.5 VBU (4.8-6.0) [4.0-6.5] at the doses of 0.1, 0.2, and 0.3 ml/kg, respectively. In the flexion group, median cranial spread was 4.5 VBU (3.6-5.8) [3.5-7.0], 5.8 VBU (5.0-7.0) [4.5-8.5], and 6.5 VBU (6.0-7.3) [5.0-8.5] at the doses of 0.1, 0.2, and 0.3 ml/kg, respectively.

Figure 2: Cranial and caudal spread of contrast medium in the high thoracic epidural space during extension or flexion of the neck. Cranial spread was greater in the flexion group, while caudal spread was greater in the extension group, *P < 0.05 versus the extension and flexion groups. Data are shown as box-and-whisker plots (10th percentile, 25th percentile, median, 75th percentile, 90th percentile). Cranial spread is expressed as positive values on the vertical axis, and caudal as negative values.

Mentions:
The cranial spread was greater in the flexion group than the extension group at the doses tested (Fig. 2) (P < 0.05). In the extension group, the median radiographic spread to the cranial direction was 3.5 VBU (2.6-3.5) [2.5-4.5], 4.3 VBU (3.5-5.5) [3.5-6.0], and 5.5 VBU (4.8-6.0) [4.0-6.5] at the doses of 0.1, 0.2, and 0.3 ml/kg, respectively. In the flexion group, median cranial spread was 4.5 VBU (3.6-5.8) [3.5-7.0], 5.8 VBU (5.0-7.0) [4.5-8.5], and 6.5 VBU (6.0-7.3) [5.0-8.5] at the doses of 0.1, 0.2, and 0.3 ml/kg, respectively.

Bottom Line:
However, the caudal spread was greater in the extension than in the flexion group.In the extension group, the contrast medium spread caudally about twice as far as it spread cranially, but there was no statistically significant difference between cranial and caudal spread in the flexion group.The flexion of the neck increased cranial spread and extension of the neck increased caudal spread.

Affiliation:
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Background: Neck flexion has been shown to increase cranial spread of contrast agent when a small fixed volume was injected into the high thoracic epidural space. The purpose of this study was to evaluate the effect of volume of contrast medium on its distribution through the high thoracic epidural space during neck extension and flexion using the rabbit model.

Methods: An epidural catheter was introduced into the epidural space of New Zealand white rabbits with the tip located at the T3-4 intervertebral level. The neck was extended or flexed (n = 8 for each group), and the contrast medium was injected with the volume increasing by increments of 0.1 ml/kg, up to 0.3 ml/kg. The spread of contrast medium was determined by counting the number of vertebral body units using lateral epidurographic images.

Results: In both groups, the total spread of contrast medium was similar, increasing continuously with injected volume. The cranial spread was greater in the flexion group than the extension group. However, the caudal spread was greater in the extension than in the flexion group. In the extension group, the contrast medium spread caudally about twice as far as it spread cranially, but there was no statistically significant difference between cranial and caudal spread in the flexion group.

Conclusions: In the high thoracic epidural space of rabbit, the contrast medium of varying doses showed limited cranial spread. The flexion of the neck increased cranial spread and extension of the neck increased caudal spread.